Are Anticonvulsants Effective for Low Back Pain?

Anticonvulsants appear to be ineffective in the treatment of low back pain (LBP) and may be associated with an increased risk for adverse events, according to a study published in the Canadian Medical Association Journal.

Nonpharmacologic interventions and nonopioid analgesics are generally recommended in clinical guidelines for the treatment of LBP, but the use of anticonvulsants, specifically gabapentinoids, has been increasing according to recent reports. “Clinically, the prescription of anticonvulsants for back and neck pain, including radicular pain in primary care, has increased by 535% in the last 10 years,” write the authors of this systematic review and meta-analysis, “This trend may be due to prescribers seeking an alternative to opioids.”

For this review, the authors searched 5 large databases for studies that compared the use of anticonvulsants (i.e., topiramate, gabapentin, pregabalin) in adult patients with LBP, sciatica, or neurogenic claudication with placebo. They were able to identify 9 placebo-controlled studies which examined the effects of these anticonvulsants for LBP and lumbar radicular pain in 859 patients.

The results showed that anticonvulsants were found to be ineffective at reducing pain or disability associated with LBP or lumbar radicular pain in 14 of the 15 comparisons. High-quality evidence demonstrated that gabapentinoids had no effect on chronic LBP vs placebo in the short term (pooled mean difference [MD] -0.0, 95% CI -0.8 to 0.7); the same was noted for lumbar radicular pain in the intermediate term (pooled MD -0.1, 95% CI -0.7 to 0.5). However, the authors did find that use of gabapentinoids was associated with an increased risk of adverse events (high-quality evidence).

With regard to topiramate, a small clinical effect on pain was noted in the short term, but there was no effect on disability (moderate-quality evidence) and very low-quality evidence showed that use was not associated with an increased risk of side effects.

Based on the findings from this systematic review the authors concluded that “evidence to date does not support the use of anticonvulsants for chronic low back pain or lumbar radicular pain.”